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TIC-QS Registration Form (Weekend)
Weekend Madrasa
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Name:
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Address:
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City/State/Zip:
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Home Phone:
Your answer
Cell/Work Phone:
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Email:
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Emergency Contact:
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Phone Number:
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Student Information (List first and last name, gender, and birth date.)
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New Students:
Yes
No
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If Yes (List student names) :
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Disclaimer and Signature
I (parent name) the legal guardian of (student name) have read and understood the conditions and policies and accept full responsibility.
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Signature:
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Date:
MM
/
DD
/
YYYY
OFFICE USE ONLY
Payment Received:
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Payment Balance:
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Payment Method:
Cash
Debit/Credit Card
Check
Money Order
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Payment Received By:
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Date:
MM
/
DD
/
YYYY
Reviewed By:
Your answer
Date:
MM
/
DD
/
YYYY
Approved By:
Your answer
Date:
MM
/
DD
/
YYYY
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